What are Voice or Vocal Disorders: Types, Causes, Symptoms, Treatment, Prevention

Voice disorders also known as vocal disorders refers to any medical condition which affects the quality of your sound. Voice or vocal disorders adversely affects one or more parameters of your voice such as volume, pitch, tone etc. Voice is produced by the vibration of vocal chords. Voice or vocal disorders affects the vocal cord and does not allow it to vibrate normally.

Sound is actually the vibrations produced in the air. Our lungs pushes out the air through our mouth and it passes through vocal cord that produces vibrations in the air. Vocal cord, also referred as voice box and is made up of two layers of tissues present inside the larynx.

There are various types of voice or vocal disorders that can affect your voice. These voice disorders or vocal disorders have been classified into various categories to study each type individually. Voice or vocal disorders have been classified into four main categories: Functional, Neurogenic, Structural and Psychogenic. However, voice disorders may not necessarily fit into only one category and thus it can be extremely difficult for a doctor to classify a particular voice disorder in appropriate category. It also makes it harder to determine the cause of a particular voice disorder.

1. Functional Voice or Vocal Disorders

   Functional voice or vocal disorders refers to those case of voice disorders in which there is no degradation in the structure of vocal cord but it is unable to function properly due to tension in its muscles. Thus, vocal cord is not able to produce normal voice. Below mentioned are some of the types:

   • Anterior-posterior constriction.
   • General muscle tension dysphonia.
   • Hyper Adduction.
   • Pharyngeal constriction.
   • Hyper Abduction.
   • Vocal fold bowing.
   • Ventricular phonation.

2. Neurogenic Voice or Vocal Disorders

   Voice or vocal disorders that are caused due to inability of nervous system to control vocal cord are referred as neurogenic voice or vocal disorders. Neurogenic voice disorders includes weakening or complete paralysis of vocal cord, tremor etc. Individuals with neurogenic disorders may also experience difficulty in swallowing food and there is always a risk of pneumonia as the food while swallowing may enter into wind pipe instead of food pipe and end up in lungs. Types of neurogenic voice or vocal disorders include:

   • Laryngeal Dystonia or spasmodic dysphonia.
   • Benign Essential Tremor.
   • Full or partial paralysis.
   • Voice or vocal disorders caused by another neurological disorder which includes Lou Gherig’s Disease/Amyotrophic Lateral Sclerosis, parkinson’s condition, myasthenia gravis.

3. Structural Voice or Vocal Disorders

   Structural disorders refers to those case of voice or vocal disorders in which the degradation in voice is caused by some problem in fluid or tissue forming the vocal cord. Such problems in vocal cord prevents it from vibrating normally and leading to a harsh voice. The structural voice or vocal disorders include:

   • Cysts
   • Contact Ulcers
   • Granuloma
   • Hyperkeratosis
   • Hemorrhage
   • Leukoplakia
   • Laryngitis
   • Nodes or nodules
   • Polyps
   • Papilloma
   • Trauma
   • Miscellaneous growths

4. Psychogenic Voice or Vocal Disorders

   Sometimes, voice disorders may also be associated with certain psychological disorders as production of voice is also related to the feelings and emotions. Below are some of the types:

   • Puberphonia or mutational falsetto.
   • Conversion dysphonia or aphonia.

Voice or vocal disorders may be caused due to various types of problems and thus it is difficult to specify actual causes. All those activities that may cause injury to vocal cord such as frequently clearing of throat, screaming all the time, injury, smoking etc can cause voice or vocal disorders. Voice or vocal disorders may also be caused by some other factors such as severe throat infections, acidity in stomach, cancer, viral infections or other diseases that may affect vocal cords.

Symptoms for various types of voice or vocal disorders are more or less similar. Common symptoms of voice or vocal disorders are as follows:

• Harsh voice.
• Inability to produce high notes in voice.
• Deeper voice.
• Difficulty in producing voice.

Otolaryngologist or ENT specialist starts by inspecting your throat in case voice change persists for a long period. The otolaryngologist starts by analyzing your symptoms related to voice or vocal disorders and figure out the possible causes for disorder. There are certain tests that are used to examine vocal cords for any disorder. Some of these tests are as follows:

• Laryngoscopy test for diagnosing voice or vocal disorders involves inspection of throat by using various direct and indirect methods. The simplest way is to reflect light into your throat by using a mirror and try to look for any problems in vocal cord. Modern laryngoscopy techniques such as fiberoptic laryngoscopy involves sending a thin fiber optic into your throat via nose. This small tube carries light and is fitted with a small camera.
• Laryngeal electromyography, or EMG test for voice or vocal disorders involves sending electrical waves into your throat to examine for any disorders in muscles of the vocal cord. These electrical signals are sent into the throat using a thin needle and then recording the waves. These waves are processed and analyzed in the computer screen.
• Another test for diagnosing voice or vocal disorders is stroboscopy. This test involves examination of vibrations in vocal cord by inserting a small probe consisting of a light source and a camera.
• Imaging techniques such as MRI and X-rays can also be used to examine the structure of vocal cord without any invasion.

The treatment for voice or vocal disorders completely depends on the type of the voice or vocal disorder. Below are some of the treatments for voice or vocal disorders:

Voice therapy for treating the voice or vocal disorders is used for treating the most common causes of voice disorders such as abuse or voice misuse. Voice therapy uses proper voice technique and the specialists will teach these techniques so that the patient does not abuse or misuse their voice. Voice therapy is also used when a patient had a vocal fold growth surgery.

• If the patient is diagnosed with reflux laryngitis, then anti reflux medication is prescribed to treat the disorder.
• The voice or vocal disorders caused by hypothyroidism disease can be managed by observing and treating the levels of thyroid hormone levels.
• If the voice or vocal disorders are caused by spasmodic dysphonia or muscle spasms, then botulinum toxin which is of type A is injected to the muscles to relieve the problem.

The key to treatment of voice or vocal disorders lies in detecting the causes of voice disorder and analyzing the condition of throat. In some cases of voice or vocal disorders with laryngeal inflammation, postnasal drainage often helps in getting rid of voice disorder. In other cases where traditional methods are not able to treat the disorders, surgical methods may be need to correct problems in vocal cord.

The treatment for each type of voice or vocal disorder is different, so it is better to consult your doctor for the recovery period or healing time for the same, also you can ask questions such as the recurrence of the voice or vocal disorders.

There are few ways to prevent voice or vocal disorders:

• Stopping smoking is a good way to prevent voice or vocal disorders.
• If you are in a job where you have to talk or give speeches every single day, then you better consult an ENT specialist so that he/she can provide guidelines (such as voice warm up before a long speech etc..) in order to prevent voice or vocal disorders in the long run.
• Voice exercises are also useful in preventing voice or vocal disorders when you are in a job where you have to yell every day.